BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE URBAN

   12^th DAY OF SEPTEMBER 2019

Complainant/s: -                           

Smt.Shobha Hegde

W/o Sudhakara Hegde,

A/4, 705, Thungabadra

Block, National

Games Complex,

Koramangala,

Bengaluru.

By Adv.Sri.K.Chandranath Ariga

V/s

Opposite party/s:-    

Bajaj Allianz Life

Insurance Co. Ltd.,

2^nd Floor, Silver Line

Arcade, Opp: Pizza Hutt, No.897/B, 30 feet

Road, 6^th Block,

Koramangala,

Bengaluru-95.

Rep.by Manager

By Adv.Sri.J.R.Jagadish

ORDER

SRI. S.L PATIL, PRESIDENT

The Complainant has filed this complaint U/s 12 of Consumer Protection Act 1986, seeking direction against the Opposite Party (herein after called as OP) to refund Rs.7,32,905/- with interest at 18% p.a.; to pay damages of Rs.10 lakhs; to pay cost of Rs.25,000/-.

2. The brief facts of the complaint are as under:

The Complainant submits that, OP approached her and offered ULIP policy which is an investment risk policy and the benefits are linked to the stock market. The commencement of the said policy was on 20.05.08 and date of vesting was on 20.05.13 i.e. duration of 5 years. The premium is Rs.3 lakh per year. The Complainant paid 3 premiums regularly as per the terms and conditions of the policy. The maturity value of the policy is Rs.10,98,905/-. On 21.05.13, the Complainant visited the OP and requested for the release of the maturity amount. But OP paid only Rs.3,62,638/-. The Complainant protested and lodged a written complaint with OP. Later, OP sent a new policy, but the Complainant rejected. She requested the OP to release the retained amount of Rs.7,36,267/- immediately required for the heart surgery of her husband. The offer of OP to invest the amount for another period of 30 and odd years is ridiculous. The money invested by the Complainant is for her necessity and it is not for the benefit of the OP and they cannot decide the investment for her. Non-release of the amount has put the Complainant in great hardship. Hence this complaint.

3. After issuance of notice, OP did appear and filed version. The sum and substance of the version is that, OP admits in respect of issuing the said policy. Further stated that, the premium of the policy was Rs.3 lakh per year and was payable annually and that the vesting of the policy was on 20.05.13 and that the premium paying term was five years and that the daughter of the Complainant was the beneficiary and that the risk of the investment will be on the policy holder. The Complainant was supposed to pay premiums for 5 consecutive years, but she paid renewal premiums only for three years and in all paid a sum of Rs.9 lakh to OP and did not pay the renewal premiums for the 4^th and 5^th year for the reasons best known to her. The amount Rs.10,98,905/- is not the maturity amount but it is the fund value available in the account of the Complainant as on the date of vesting of the policy of the Complainant i.e. as on 20.05.13. Infact, the Complainant was aware of the fact that there cannot be any maturity amount in the policy secured by her, but it is the fund value and that out of the said fund value amount, the Complainant has to either reinvest 100% or can withdraw 1/3^rd amount and reinvest 2/3^rd amount and continue getting pension. She can either continue with the OP Company for reinvestment or can opt for any other insurance company but the reinvestment is compulsory as per the terms and conditions of the policy, as it was a pension policy. The OP further submits that, she accepted the policy in question and as such she cannot raise any grievance against the terms and conditions of the said policy after the lapse of nearly 6 years from the date of commencement of policy. The Complainant in the present case invested 2/3^rd amount (67)% of Rs.7,36,267/- in the OP company and as such 1/3^rd amount (33%) of Rs.3,62,638/- was refunded to the Complainant. The Complainant received the said amount and thereafter almost after 3 months complained that she was not satisfied with the policy. But it was explained to her that as per the terms of the policy, there is no occasion or condition to close the pension policy and that the OP cannot close the policy. The terms and conditions of the policy are binding on the policy holder as well as the insurance company. Hence, there is no deficiency of service on the part of OP. Hence on these grounds and other grounds OP prays for dismissal of the complaint.

4. The Complainant to substantiate her case filed affidavit evidence and produced the documents. OP filed affidavit evidence and produced the documents.  The Complainant filed written arguments. We have gone through the available materials on record. Heard.

5. The points that arise for our consideration are:

1. Whether the Complainant proves the deficiency of service on the part of OP, if so, entitled for the relief sought for?

2. What order?

        6. Our answer to the above points are as under:

Point No.1:- Partly in the affirmative

Point No.2:- As per final order

REASONS

7. Point No.1: We have briefly stated the contents of the complaint as well as the version filed by OP.  The undisputed facts which reveal from the pleadings of the parties go to show that the Complainant has accepted the policy by acknowledging the letter from OP (policy No.0098374573 dtd.20.05.08). Her daughter is beneficiary for the said policy. It is also not in dispute that, the policy commenced from 20.05.08. The premium was Rs.3 lakhs per year with a premium paying term of five years. The total duration of the policy is five years. The premium of Rs.3 lakhs p.a. has to be paid for three continuous years. The date of vesting of the policy was 20.05.13. It is also not in dispute that, the Complainant has made the payment regularly and three premiums were paid as per the terms and conditions of the policy. The maturity value of the policy was Rs.10,98,905/-. When the Complainant’s husband was fell ill, for his treatment and also to discharge the home loan, she required finance. Therefore, she had visited the office of the OP and requested for release of the matured amount. In this context, the OP took several signature of her on the bond to pay the maturity value of Rs.10,98,905/-. Against the said maturity value, OP has credited only Rs.3,62,638/- to her account through ECS. Immediately, she enquired and lodged a written complaint with OP seeking full maturity value of the policy. The OP has issued an acknowledgement for the complaint dtd.21.05.13. Thereafter, she received a new policy on 24.05.13 by courier.

8. The main grievance of the Complainant is that, OP without her notice opened a new policy which contains a clause stating as “that the policy holder has the right to reject this policy within 15 days of the receipt of the policy.” Immediately on receipt of the said policy, she wrote a letter dtd.03.06.13 to the OP informing that she is not interested in new policy and demanded the balance amount since she required for the heart surgery of her husband and also to realize the home loan. But OP did not reply. According to the Complainant, the very act of the OP is illegal as it has wrongly retained a sum of Rs.7,36,267/-.

9. The say of the OP is that, it is the Complainant who has availed the new policy knowing the contents of the same. But now she has raised grievance stating that, OP without made known to the contents of the terms and conditions obtained her signature on the new policy. Further submits that, the Complainant is bound by terms and conditions of the new policy.

10. In the light of the rival contentions, we placed reliance on the available materials on record. Even if assuming for a moment that the Complainant has received new policy for which she has got 15 days time to agree the terms and conditions of the policy and also she is at liberty to cancel it. The available materials on record in particularly doc.3, 5 & 6 which are the ‘Service Request Acknowledgement Letter’ dtd.21.05.13 sent by OP; undated letter sent by the Complainant to OP in respect of rejecting to enter in to any new policy and demanded for the balance amount of Rs.7,50,992/-; postal receipt dtd.03.06.13 for having sent the said undated letter to OP through post, clearly goes to show that, in respect of issuance of the said letter/doc.5 and also sent the said letter by postal authorities/doc.6 are not disputed by OP. The Complainant informed the OP stating that, she is not interested to avail the new policy and sought for the refund of remaining amount Rs.7,50,992/-.  When the Complainant did not agree to the terms and conditions of the said new policy, under such circumstances, she is at liberty to cancel the policy. Under such circumstances, she is entitled for the withholding amount of Rs.7,32,905/- as prayed in relief column. Accordingly, we come to the conclusion that, the claim repudiated by the OP on technical grounds has no legs to stand. The Hon'ble Supreme Court in such type of cases repeatedly held that the insurance company cannot repudiate the claim on technical grounds in mechanical manner will results in loss of confidence of policy holders in insurance industry. In this context, we placed reliance on the decision of Hon'ble Supreme Court in the case of Om Prakash vs. Reliance General Insurance and Anr. in Civil Appeal No.15611/2017, dtd.04.10.17, reported in IV (2017) CPJ 10 (SC), wherein it is held as under:

Consumer Protection Act, 1986 – Sections 2(1)(g), 14(1)(d), 23 – Insurance – Theft – Delay in intimation – Violation of policy conditions alleged – Claim repudiated – deficiency of service –District Forum dismissed complaint – State Commission dismissed appeal – National Commission dismissed revision – Hence appeal – Decision of insurer to reject claim has to be based on valid grounds – Rejection of claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy holders in insurance industry – If reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on ground of delay – It would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct Investigator – Condition regarding delay shall not be a shelter to repudiate insurance claims which have been otherwise proved to be genuine – Consumer Protection Act aims at providing better protection of interest of consumers. It is a beneficial legislation that deserves liberal construction – This laudable object should not be forgotten while considering claims made under Act – Appellant has given cogent reasons for delay of 8 days in informing respondent about incident – Investigator had verified theft to be genuine and payment of Rs.7,85,000/- towards claim was approved by Corporate Claims Manager – National Commission, therefore, is not justified in rejecting claim of appellant without considering explanation for delay  Claimant is entitled for a sum of Rs.50,000/- towards compensation – Respondent Nos.1 & 2 are directed to pay a sum of Rs.8,35,000/- to appellant with interest at 8% p.a. from the date of filing of the claim petition till the date of payment.

11. With regard to pay the damages of Rs.1 lakhs as compensation, we do not find just reason to award such huge amount by way of compensation. Anyhow, looking to the mental agony and also sufferings for withholding the said amount, we deem it just and proper to award Rs.25,000/- by way of damages with litigation cost of Rs.5,000/-. Accordingly we answered point No.1 partly in the affirmative.

          12. Point No.2: In the result, we passed the following:         

  O R D E R

The complaint filed by the complainant is allowed in part.

2. The OP is directed to refund the retained amount of Rs.7,32,905/- to the Complainant within six weeks from the date of receipt of this order, failing which, the said amount carries interest at 8% p.a. from the date of this order till the date of realization.

3. The OP is also directed to pay compensation of Rs.25,000/- and litigation cost of Rs.5,000/- to the Complainant

4. This order to be complied by OP within six weeks from the date of receipt of this order, failing which the Complainant is at liberty to have the redress as per law.

Supply free copy of this order to both the parties.

(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Forum on this 12^th day of September 2019)

        MEMBER                                             PRESIDENT

Witnesses examined on behalf of the Complainant dated.02.08.14

Sri.Shobha Hegde  

Copies of Documents produced by the Complainant:

Witnesses examined on behalf of the OP dated.25.09.14

Sri.M.Aravinda, South Zonal Legal Manager, Authorized Representative of the OP.   

Copies of Documents produced by OP

            MEMBER                                           PRESIDENT